IN SIXTY:
Cancer Patient Journey
March 3, 2014
RELEASE AVAILABLE AT: http://news.gov.mb.ca/news/index.html?item=11726
2. Diagnosis
1. Routine Visit to Doctor
Good
News
Tests to rule
out simple
explanations
Patient
Visit
Preventative Measures
Rapid Assessment
Suspicion
of Cancer
Watchful Waiting
Tests, Pathology,
Imaging
Referral
GP Disbelief/
Misdiagnosis
•
•
•
WAIT
Referral to
specialist
Scheduling of tests
Referral to surgery
Medical, Surgical,
Lifestyle Interventions
Untreatable:
Go to 5:
(Supportive/
Palliative Care)
Treatable
Cancer
Referral to
Oncologist
6. Five Years Later
Unclear
Diagnosis
Diagnos
is
Results
 Learn everything you can
about this type of cancer
 Talk to your family
 Check insurance and
finances
Referral to
Surgery
 Talk to your employer
 Find a support group
WAIT
Goo
d
New
s
Living Cancer
Free
Staging
Scheduling
WAIT
3. Treatment
Treatment
5. Later
Yes
No
Drugs not
covered
Recurrence?
No
Decisions to continue
with further treatment
Consider:
• Risks
• Side effects
• Quality of life
• Financial impacts
Yes
4. Follow
-up
Treatmen
t not
sufficient
Go to 3:
Treatment
Investigate Clinical
Trials
Goo
d
New
s
Results
Chemo
Therapy ?
Radiation
Therapy ?
Try special
request
Private Payment
Fund Raising
WAIT
End of
Life
Supportive/
Palliative
Care
More tests,
pathology,
imaging
Recovery
Surgery ?
Stem Cell or
Bone
Marrow
Transplant ?
If necessary, return to oncology or surgery
to choose another round of treatment
2. Diagnosis
1. Routine Visit to Doctor
Good
News
Tests to rule
out simple
explanations
Patient
Visit
Preventative Measures
Rapid Assessment
Suspicion
of Cancer
Watchful Waiting
Tests, Pathology,
Imaging
Referral
GP Disbelief/
Misdiagnosis
•
•
•
WAIT
Referral to
specialist
Scheduling of tests
Referral to surgery
Medical, Surgical,
Lifestyle Interventions
Untreatable:
Go to 5:
(Supportive/
Palliative Care)
Treatable
Cancer
Referral to
Oncologist
6. Five Years Later
Unclear
Diagnosis
Diagnos
is
Results
 Learn everything you can
about this type of cancer
 Talk to your family
 Check insurance and
finances
Referral to
Surgery
 Talk to your employer
 Find a support group
WAIT
Goo
d
New
s
Living Cancer
Free
Staging
Scheduling
WAIT
3. Treatment
Treatment
5. Later
Yes
No
Drugs not
covered
Recurrence?
No
Decisions to continue
with further treatment
Consider:
• Risks
• Side effects
• Quality of life
• Financial impacts
Yes
4. Follow
-up
Investigate Clinical
Trials
Goo
d
New
s
Chemo
Therapy ?
Radiation
Therapy ?
Try special
request
Primary Areas of Focus
Private Payment
Fund Raising
Surgery ?
Stem Cell or
Bone
Marrow
Transplant ?
GOAL STATEMENT: To reduce
the time from suspicion
of cancer to first
Recovery
Results
treatment to no longer than 60 days, by no later than 2016, in a sustainable
manner that improves
the quality of the cancer
patient
experience.
If necessary,
return to oncology
or surgery
Go to 3:
Treatmen
t not
sufficient
Treatment
WAIT
End of
Life
Supportive/
Palliative
Care
More tests,
pathology,
imaging
to choose another round of treatment
IN SIXTY:
Disease Site Group Priorities
1.
2.
3.
4.
5.
Breast
Colorectal
Lung
Prostate
Lymphoma
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
Manitoba Cancer Partnership Steering Committee
Current and future cancer patients & their families
Deputy
Minister
Project
Mgmt
Team
Primary
Health
Care
Cancer
Working
Group
Clinical Lead
Admin Lead
Improvement
Sub-Group(s)
Manitoba Cancer Partnership
Steering Committee
Co-Chair: Arlene Wilgosh
Clinical Lead
Admin Lead
Improvement Improvement
Sub-Group(s) Sub-Group(s)
Rapid
Improvement
Community
of Practice
Co-Chair: Dhali Dhaliwal
Medical Radiation
Oncology
Working
Group
Patient
Participation
Advisory
Group
Vulnerable
Cancer
Patients
Working
Group
Clinical Lead
Admin Lead
Clinical Lead
Admin Lead
Patient
Participants
Clinical Lead
Admin Lead
Improvement Improvement
Sub-Group(s) Sub-Group(s)
Improvement
Sub-Group(s)
Community
Surgery
Emergency
Cancer
Cancer
Working
Working
Diagnostic
Hub
Group
Cancer Group
Disease Specific
WorkingGroups
Working
Group , Lymphoma)
(Breast, Colorectal, Lung, Prostate
Group
Clinical Lead
Admin Lead
Health Senior
Leadership
Council
Clinical Lead
Admin Lead
Information
Mgmt
Working
Group
Clinical Lead
Admin Lead
Program
Evaluation
and
Monitoring
Working
Group
Admin Lead
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
http://www.bresslercompany.com/wp-content/uploads/2012/11/Calendar_Fotolia_46378485_S-600x300.jpg
60 days
29 % of Manitoba’s
breast patients
moved from suspicion
of cancer to
treatment in 60 days
or less (2010)
90 % of Manitoba’s
breast patients
moved from suspicion
of cancer to
treatment in 160 days
or less (2010)
IN SIXTY – Use of Lean Six Sigma to Drive Improvement
DMAIC Methodology
Implement &
Verify Solution
Find Solution
Define
Define the
problem
properly so
that you solve
the right
problem right
Measure
Measure the asis process in
order to
characterize the
problem and to
enable
measurement
of improvement
Analyze
Hunt for clues
using analysis
and experience
Improve
Test
hypotheses
and get a
repeatable
solution
Control
Solution
Control
Keep new
process
locked in
Systemic Opportunities
 Direct referral
 Same day service for mammography,
ultrasound, and biopsy
 Breast surgery slating improvements:
o Coordination of surgery and plastics
o Central referrals
o Slating “ownership” review
What does this mean for a
breast cancer patient?
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
Evolution of the
Community
Cancer
Program
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
IN SIXTY: The Deliverables
1. Establish Manitoba Cancer Partnership Steering Committee
2. Implement efficiency & quality improvement initiatives within
each care environment
3. Implement effective and efficient coordination, integration,
and transitions between care environments.
4. Enhance Community Cancer Program Services
5. Implement Rapid Diagnostic Networks
6. Reduce Disparities of Access to Cancer Control Programs
7. Enhance capacity for assessment, measurement,
monitoring, and reporting
IN SIXTY: The Deliverables
Objective:
Use existing data sources maintained by CPJI’s partner
organizations to measure the pre-Initiative cancer patients’ journey
from suspicion to treatment, beginning with breast cancer.
Methods:
Used record linkage to combine the Manitoba Cancer Registry and
various population-based health services and clinical datasets for
all Manitoba women diagnosed with breast cancer in 2010. With
clinical advisors, developed an algorithm for assigning key points
along the cancer journey. The algorithm was built on a sample of
cases and validated through chart review before being applied to
the population. Standard summary statistics and cumulative
incidence (time to event) curves were used to describe the
patients’ experience.
IN SIXTY: Tracking the Journey
Integration of Key Systems
Community
EMR & FFS
Abstract
eReferral
and Patient
Access
Registry
Tool
MANITOBA
CANCER
TRACKING
SYSTEM
- Suspected Cancer
- Diagnosed Cancer
Radiology
Information
System
(RIS) and
Picture
Archiving
System
Lab
Information
System
(LIS)
CancerCare
Manitoba
Electronic
Health
Record
(ARIA)
CANCER PATIENT
JOURNEY
TRACKER DATA
MART
Hospital
EMR and
Discharge
Abstract
Systems
Providers
Public
Reporting
Hospital
Admission
Discharge
Transfer
System
EDIS –
Regional
Emergency
Department
Information
System
Thank-you
Questions…?